La Trobe Uni transforms midwifery care for First Nations women

A Victorian healthcare program has significantly improved the health of pregnant Indigenous women and their babies by providing continuity of midwifery care from the early stages of pregnancy through to labour, birth and the first weeks of a baby’s life.

Indigenous women in general have double the national average rates of preterm births, double the rate of low birthweight babies, and three times or more the rate of maternal mortality.

“The question of health differences for First Nations people is high on the government agenda. This model has actually, literally ‘closed the gap’,” says Helen McLachlan, Professor of Midwifery at La Trobe University.

The midwifery program conceived jointly by La Trobe, the Victorian Aboriginal Community Controlled Health Organisation and three Victorian hospitals, ensures eligible pregnant Indigenous women are assigned a dedicated midwife they can get to know and trust during pregnancy. Their midwife is then available to provide care during labour, birth and after the baby is born.

Jindara, the 100th baby born in the First Nations midwifery program.
Jindara, the 100th baby born in the First Nations midwifery program.

McLachlan says too few Australian women have access to this “gold standard” of midwifery care. She led one of the largest studies in the world (COSMOS) on the provision of maternity care which found that continuity of midwifery care for women resulted in fewer caesarean section births, fewer babies requiring special or intensive care, and improved mothers’ and babies’ health.

“Before we started, only 34 women having a First Nations baby had ever received this continuity of care model, compared with thousands of other women from different backgrounds,” she says. “It’s the ‘inverse care law’. The women in most need of this care are the least likely to get it.”

Called Baggarrook Yurrongi (“woman’s journey” in Woiwurrung language), the program saves government money spent on healthcare in the long term, McLachlan adds, because babies born to women in the program are healthier overall.

The program began with a request from the Victorian Aboriginal Community-controlled Health Organisation. A team from the organisation had come to listen to McLachlan and her colleagues present the COSMOS trial findings and then wanted to establish a partnership for a new continuity of care program for women having a First Nations baby in Victoria.

Initial funding from the National Health and Medical Research Council was received by La Trobe in 2017 to develop and set up the program in three hospitals in Melbourne in conjunction with their local First Nations community organisations. “The primary aim of our study was to see if hospitals could successfully implement this culturally safe model to all women having a First Nations baby,” McLachlan says.

When McLachlan and her colleagues stopped counting, 700 Indigenous babies had been born to women in the program, which is now embedded at the three hospitals. Four First Nations midwives work at one of the hospitals, and all the non-Indigenous midwives have received cultural sensitivity training.

“Health services have not always been a safe place for First Nations people,” McLachlan says. “These were the settings where babies were stolen, and women often experienced racism. This model turned that around; women felt safe and cared for. We now want to roll this program out so more women having a First Nations baby can have access to this gold standard of care.”

The Australian